Hepatitis C clinical manifestations and treatment strategies essays
Hepatitis C clinical manifestations and treatment strategies essays
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Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice. He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.
Other blood work: Direct bili 1 mg/dL, alk phos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative Hepatitis C clinical manifestations and treatment strategies essays.
Patient diagnosis: Acute Hepatitis C.
List some clinical manifestations typically seen in Hepatitis C and major treatment strategies.
Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight. Both responses must be a minimum of 150 words, scholarly written, APA formatted, and referenced. A minimum of 2 references are required (other than your text). Refer to grading rubric for online discussion.
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Thank you for your thorough post. As a provider, there are many resources available to help us treat this population. You may want to look at the ECHO project and keep this resource for clinical: https://www.hcvguidelines.org/
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Steven Bartos posted Feb 24, 2021 7:33 PM
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Hepatitis C (HVC) is a virus that predominantly infects the hepatocytes of the liver. It is estimated that 85% of patients with an acute infection eventually develop a chronic infection. Patients initially show elevated liver labs, AST and ALT. Chronic HCV is associated with liver failure, cirrhosis, and liver cancer. Patients used to be treated with interferon (IFN)-based interventions, but those had several negative side effects. These days, patients are treated with direct acting antiviral agents (DAAs) which have been shown to provide a functional cure, known as sustained virologic response (Tang, 2016).Other manifestations include arthralgia/myalgia, which is reported in 40 – 80% of patients, and displays as symmetric joint pain primarily in the knees and hands. INF treatments for the HCV may actually worsen these joint symptoms, which makes these cases that much more complicated. Sicca syndrome is an immune disorder that attacks salivary and tear glands of the mouth and eyes, causing them to dry up. This is another symptom that has been shown to subside with HCV treatment (Cacoub et al., 2016). Diabetes mellitus type 2 has also been linked with chronic HCV. Small focused studies with DAA interventions have shown decreased diabetes markers such as A1C, but research notes that larger studies need to be replicate results. Lastly, membranoproliferative glomerulonephritis is one of the most common manifestations of the kidneys. Patients present with renal insufficiency, proteinuria, and hematuria. DAAs usually lead to improvement of such manifestations and overall kidney function (Tang, 2016).Cacoub, P., Comarmond, C., Domont, F., Savey, L., Desbois, A.C., & Saadoun, D. (2016). Extrahepatic manifestations of chronic hepatitis C virus infection. Therapeutic Advances in Infections Disease, 3(1), 3 – 14. https://doi.org/10.1177/2049936115585942less1 UnreadUnread5 Views Views Hepatitis C clinical manifestations and treatment strategies essays
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View profile card for Sheryl Dixon
Last post March 7 at 6:26 PM by Sheryl Dixon
Tang, L., Marcell, L., & Kottilil, S. (2016). Systemic manifestations of hepatitis C infection. Infectious Agents and Cancer, 11(1), 1 – 8. https://dx.doi.org/10.1186/s13027-016-0076-7
References
HCV is a systemic disease, where the manifestations of HCV extend beyond the liver as extrahepatic manifestations. One of the more common manifestations is cryoglobulinemic syndrome (MCS), which is small vessel vasculitis resulting in symptoms such as skin lesions / ulcers, joint pain, peripheral neuropathy, and renal disease. Treatment that targets this syndrome include rituximab and antiviral therapy. B cell Non-Hodgkin’s Lymphoma (B-NHL) is another typical manifestation of HCV. IFN-based treatments have been shown to benefit patients with B-NHL; however, DAA treatment studies are limited to case reports, but the results remain promising as lymphoma regression was noted with DAA therapy (Cacoub et al., 2016).
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Lois Chappell posted Mar 3, 2021 9:23 PM
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View profile card for Aina Oluwo
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Huether, S. E., McCance, K. L., & Brashers, V. L. (2020). Understanding pathophysiology (7th ed.). Elsevier.
Chung, R. T., Ghany, M. G., Kim, A. Y., Marks, K. M., Naggie, S., Vargas, H. E., Aronsohn, A. I., Bhattacharya, D., Broder, T., Falade-Nwulia, O. O., Fontana, R. J., Gordon, S. C., Heller, T., Holmberg, S. D., Jhaveri, R., Jonas, M. M., Kiser, J. J., Linas, B. P., Lo Re, V.,…Workowski, K. A. (2018). Hepatitis c guidance 2018 update: Aasld-idsa recommendations for testing, managing, and treating hepatitis c virus infection. Clinical Infectious Diseases, 67(10), 1477–1492. https://doi.org/10.1093/cid/ciy585
The goal for treatment of Hepatitis C is to have the absence of detectable HCV RNA in blood samples 12 weeks after completion of treatment (Chung et al., 2018). The most common treatment for HCV is anti-viral medications given to an infected patient for between 8-12 weeks (Chung et al., 2018). The duration of treatment is dependent on if cirrhosis is involved and if there is cirrhosis, a patient will undergo treatment for the longer extent of 12 weeks (Chung et al., 2018). Liver transplant may become necessary if liver inflammation causes too much damage to the liver (Falade- Nwulia et al., 2017) Hepatitis C clinical manifestations and treatment strategies essays. Treatment should also include education on ways to prevent re-infection.
Hepatitis C (HVC) is a viral disease that most commonly effects the liver and is commonly transmitted by contact of infected body fluids, intravenously, or by broken skin and mucous membranes (Huether et al., 2020). HVC is generally a chronic condition that is often times asymptomatic, but can present with symptoms of cirrhosis, hepatocellular carcinoma, and glomerulonephritis (Falade- Nwulia et al., 2017). HCV effects an estimated 3.2-5 million people in the United States and is the leading indication of liver transplants and cause of infectious disease death in the US (Falade- Nwulia et al., 2017).
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Lois Chappell posted Feb 24, 2021 8:58 PM
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Hepatitis C virus is responsible for approximately 15-20% of all acute hepatitis cases (Li & Lo, 2015). Rates of infection are noted to be greater than 70 million worldwide for chronic Hepatitis C infections (World Health Organization, 2020), which may lead to cirrhosis, hepatocellular carcinoma, insulin resistance, Type II Diabetes Mellitus, glomerulopathies, oral manifestations and death (Li & Lo, 2015). The Hepatitis C virus is small, and enveloped, has many genotypes, of which all currently are hepatogenic and pathogenic (Li & Lo, 2015). It is important for healthcare providers to understand the risk factors, testing, and treatment of this contagious disease to improve clinical outcomes and decrease transmission rates. The majority of patients diagnosed with Hepatitis C will be asymptomatic, like Mike in our case study. Many will have elevated ALT levels, but some may not. Direct and indirect tests are used to detect Hepatitis C virus in hosts. Indirect tests include IgM for recent infection, and IgG for recent or past infection. Direct tests will include virus isolation, detection of viral antigens and nucleic acids (Li & Lo, 2015). Acute hepatitis is diagnosed when there is a presence of HCV RNA and an absence of anti-HCV antibodies (Li & Lo, 2015). In certain subsets of patients including dialysis, immunocompromised, and agammaglobunemic individuals, HCV RNA maybe present without the presence of HCV antibodies (Li & Lo, 2015). Andrews, R. (2018). Family physicians can manage adults with chronic hepatitis C. American Family Physicians, 98 (7). Doi: 10.4254/wjh.v7.i10.1377.less1 UnreadUnread5 Views Views Hepatitis C clinical manifestations and treatment strategies essays
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View profile card for Sheryl Dixon
Last post February 28 at 8:29 PM by Sheryl Dixon
World Health Organization (2020). Hepatitis C. Retrieved from https://www.who.int/news-room/facr-sheets/detail/hepatitis-c.
Li, Hui-Chun, & Lo, Shih-Yen. (2020). Hepatitis C virus: virology, diagnosis, and treatment. World Journal of Hepatology, 7 (10).
References
The World Health Organization (2020) suggests both testing and treatment guidelines that include pegylated interferon with ribavirin (see attached algorhythm). The American Academy of Family of Family Physicians has published guidelines ad sources to aide primary care physicians treat and monitor chronic hepatitis C infected individuals. Since hepatitis C represents the only chronic viral illness curable by medication and most deadly (Andrews, 2018), it is imperative we recognize the risks, know the tests, and provide treatment to decrease morbidity and mortality from hepatitis C infection.
Exposure to hepatitis C is through direct percutaneous exposure to blood from an infected individual; knowing risk factors can aid with prevention and detection. At risk individuals include those with illicit injection of drugs, tattoo use, dialysis, born to infected mother, incarceration, intranasal illicit drug use, intercourse with infected partner, and blood transfusions before July 1992 (Li & Lo, 2015). Prevention, through education, is essential to reducing hepatitis C infection rates.
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Hilary Szpara posted Feb 24, 2021 8:45 PM
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People with hepatitis C virus (HCV) often present as asymptomatic, but about 25-30% of people present with symptoms such as jaundice, fever, and abdominal pain (Millman et al., 2017). Many people are not aware that they have the infection, and just present with vague symptoms like nausea and malaise (Kish et al., 2017). The current major treatments include combinations of direct-acting antiviral (DAAs) medications which work against targets of the HCV replication cycle to both block virus replication and to induce progressive clearance of the virus through cellular death of infected cells (Horsley-Silva & Vargas, 2017). The first DAA treatments were approved in 2011 and were boceprevir and telaprevir. These agents were used in conjunction with pegylated interferon-alpha and ribavirin and were only effective against HCV genotype 1 infections, had low barrier to resistance, and unfavorable side effects. These factors led to the discontinued use of these agents and introduction of newer DAA agents (Horsley-Silva & Vargas, 2017). Simeprevir was the DAA agent of choice starting at the end of 2013 and it was not a perfect treatment option but worked well in combination with sofosbuvir as the first viable, interferon free treatment regimen against HCV genotypes 1 and 4 infections (Horsley-Silva & Vargas, 2017). Other current treatment regimens include the use of nonstructural 5A complex inhibitors and nonstructural 5B polymerase inhibitors (Horsley-Silva & Vargas, 2017).Horsley-Silva, J. L., & Vargas, H. E. (2017). New Therapies for Hepatitis C Virus Infection. Gastroenterology & hepatology, 13(1), 22–31. Millman, A. J., Nelson, N. P., & Vellozzi, C. (2017). Hepatitis C: Review of the Epidemiology, Clinical Care, and Continued Challenges in the Direct Acting Antiviral Era Hepatitis C clinical manifestations and treatment strategies essays. Current epidemiology reports, 4(2), 174–185. https://doi.org/10.1007/s40471-017-0108-xless2 UnreadUnread7 ViewsViews
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View profile card for Steven Bartos
Last post February 28 at 4:38 PM by Steven Bartos
Kish, T., Aziz, A., & Sorio, M. (2017). Hepatitis C in a New Era: A Review of Current Therapies. P & T : a peer-reviewed journal for formulary management, 42(5), 316–329.
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Dennies Jones posted Feb 24, 2021 4:07 PM
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Hep C can progress to advanced liver disease if left untreated. In 15% to 20% ofinfection. Among those with cirrhosis, liver failure occurs in 20% to 30% andPrior to starting antiviral therapy, several bases- line laboratory tests need to be obtained. This includes a complete blood count, various tests of liver function (albumin, total and direct bilirubin, ALT, AST, alkaline phosphatase levels, and INR), calculated kidney function, HCV genotype and subtype, quantitative HCV RNA (HCV viral load), and HIV serology since coinfection complicates treatment ( Sulkowski, 2019, p. 56). Harding, Mariann M., Kwong, Jeffrey, Roberts, Dottie, Hagler, Debra, Reinisch, Courtney. Lewis’s Medical-Surgical Nursing E-Book (Kindle Locations 52504-52507). Elsevier Health Sciences. Sulkowski, M. S. (2019). New Options in the Treatment of Hepatitis C (HCV): Economic and Clinical Consideration for Improved Patient Outcomes. Journal of Managed Care Medicine, 22(2), 54–59. less2 UnreadUnread10 Views Views Hepatitis C clinical manifestations and treatment strategies essays
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View profile card for Eleany Yasein
Last post February 28 at 3:13 PM by Eleany Yasein
WONG, R., RUSSELL, C., & KRUGER, D. (2016). Hepatitis C virus infection: signs, symptoms, and screening. Clinical Advisor, 19(2), 37–44.
Sagnelli, E., Starace, M., Minichini, C., Pisaturo, M., Macera, M., Sagnelli, C., & Coppola, N. (2018). Resistance detection and re-treatment options in hepatitis C virus-related chronic liver diseases after DAA-treatment failure. Infection, 46(6), 761–783. https://doi-org.wilkes.idm.oclc.org/10.1007/s15010-018-1188-3
Pockros, P. J. (2021). Direct-acting antivirals for the treatment of hepatitis C virus infection. Retrieved February 24, 2021, from https://www.uptodate.com/contents/direct-acting-antivirals-for-the-treatment-of-hepatitis-c-virus-infection#
Kindle Edition.
Reference:
Sagneli et al. 2018 stated that “treatment of HCV infection has been revolutionized by the recent availability of the well-tolerated, potent directly acting antivirals (DAAs), which, used in combination, allow excellent chances for an HCV clearance, prevention of disease progression and reduction of both liver-related and overall mortality” (p. 762). There are four classes of DAAs, which are defined by their mechanism of action and therapeutic target. The four categories are nonstructural proteins 3/4A (NS3/4A) protease inhibitors (PIs), NS5B nucleoside polymerase inhibitors (NPIs), NS5B non-nucleoside polymerase inhibitors (NNPIs), and NS5A inhibitors (Pockros,2020). Pockros (2020) further explained that the main targets of the direct-acting antiviral agents are the HCV-encoded proteins vital to replicating the virus. The infectious viral structure is comprised of envelope glycoproteins in a lipid bilayer that contains the viral core protein and RNA Hepatitis C clinical manifestations and treatment strategies essays.
hepatocellular carcinoma in 10% to 15% over ten years (Wong et al., 2016).
patients with chronic HCV, cirrhosis occurs within 15 to 40 years after the initial
According to Harding et al. (2020), “Hepatitis C virus (HCV) causes a type of hepatitis that can result in both acute illness and chronic infection. Acute hepatitis C, which can be mild in presentation, can be hard to detect unless a diagnosis is made with laboratory testing. The most common causes of acute hepatitis C outbreaks are among injection drug users and MSM with HIV infection” (p. 52499). Most patients experience dark urine, nausea, jaundice, and pain.
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Jazmin Jerez-Rivera posted Feb 24, 2021 1:18 PM
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There are an array of manifestations depending on the stage of the virus. It can range from a lack of symptoms to liver failure. Some early symptoms include jaundice, fatigue, malaise, gastrointestinal and respiratory symptoms (Huether et. al., 2020). Pain in the abdomen is caused by an enlarged liver and it is common to see clay-colored stool and dark urine. A study by Yarlott et. al. reveals chronic symptoms to be hepatic encephalopathy, liver cirrhosis that can lead to hepatocellular carcinoma, portal hypertension, neuroinflammation and neuro cognitive impairment (2016). Treatment for Hepatitis C is dependent on genotype, viral load and the extent of liver damage, but is primarily treated with antiviral medications. Peginterferon alfa and ribavirin was used for initial treatment, but there are currently direct acting medications depending on the genotype of the virus (Mathew et. al., 2016). Some treatment plans include fixed and combination therapies that include “paritaprevir/ritonavir/ ombitasvir plus dasabuvir [PrOD]” (Mathew et. al., 2016, p. 6). Treatment can last 12 to 24 weeks depending on severity of symptoms and liver cirrhosis. Liver transplantation can be considered for serious complications.Huether, S. E., McCance, K. L., Brashers, V. L. (2020). Understanding Pathophysiology (7 Ed.). Elsevier.Yarlott, L., Heald, E., & Forton, D. (2017). Hepatitis C virus infection, and neurological and psychiatric disorders–A review. Journal of Advanced Research, 8(2), 139-148 Hepatitis C clinical manifestations and treatment strategies essays.less1 UnreadUnread5 ViewsViews
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View profile card for Melissa Morgan
Last post February 28 at 10:37 AM by Melissa Morgan
Mathew, S., Faheem, M., Ibrahim, S. M., Iqbal, W., Rauff, B., Fatima, K., & Qadri, I. (2016). Hepatitis C virus and neurological damage. World journal of hepatology, 8(12), 545–556. https://doi.org/10.4254/wjh.v8.i12.545
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Gisselle Mustiga posted Feb 25, 2021 10:56 AM
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Hepatitis C is a progressive viral disease of the early. This disease can be transmitted through blood and bodily fluids (Wong et al., 2016). Common modes of transmissions include unsterilized need sharing, occupational hazards, and household items (toothbrushes and razors). This disease may be asymptomatic when first infected, which is relatable with Mike. It can also be inferred that Mike was infected from illicit IV drug use. The initial manifestations of this disease can be limited to mild hepatomegaly. Mike’s blood work showed abnormal LFTs and positive Hep C, however are uncommonly found early on in the disease. The patient can develop liver cirrhosis anywhere from 15-40 years after the initial infection. Due to cirrhosis individuals can progress to liver failure and hepatocellular carcinoma. Some other manifestations include hypoalbuminemia with edema, ascites, fluid retention, lethargy, coagulopathy. Patients face other challenges including, nausea, vomiting, and pruritus. Imaging can show hepatomegaly with a decrease in nodule size. On physical exam jaundice, spider nevi, gynecomastia, and testicular atrophy can be noted. Another noted manifestation is non-healing skin ulcers, the study that reported this was based on one case study, more data will need to be collected in order to solidify these findings (Fraser, 2020). The infection may affect other organs such as the kidneys, skin, joints, and the nervous system (Wong et al., 2016). There have been some drugs approved by the FDA, Peginterferon alfa-2a, Peginterferon alfa-2b, and Ribavirin. Drug treatment utilized depends on the HCV genotype, viral load, comorbidities, presence of cirrhosis, and previously utilized treatments. Clinicians are trying to get a sustained virological response. This is an undetectable HCV-RNA level 24 weeks after the completion of the treatment therapy.Wong, R., Russell, C., & Kruger, D. (2016) Hepatitis C clinical manifestations and treatment strategies essays. Hepatitis C virus infection: signs, symptoms, and screening. Clinical Advisor, 19(2), 37–44. less1 UnreadUnread7 ViewsViews
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View profile card for Candice Russell
Last post February 27 at 10:02 AM by Candice Russell
Fraser, B. (2020). Chronic hepatitis C-related cryoglobulinaemic vasculitis manifesting as non-healing skin ulcers: a case presentation. Wound Practice & Research, 28(4), 181–188.
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Sheryl Dixon posted Feb 24, 2021 8:20 PM
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The major risk factors for Hepatitis C Virus (HCV) acquisition are injection drug use, receipt of a blood transfusion or organ transplant prior to 1992, exposure to an infected sexual partner, occupational needle stick injury, non-sterile tattooing, and mother-to-child transmission. During the past decade there has been a surge in the number of reported new annual acute HCV infections that in large part is attributable to the opioid epidemic and associated injection drug use. In addition, there has been recognition of a sexually transmitted hepatitis C epidemic among men who have sex with men (MSM), particularly men with HIV infection (Brau, 2013).Malaise, anorexia, and fatigue are common signs and symptoms, sometimes with low-grade fever and nonspecific upper abdominal discomfort. Jaundice is usually absent Hepatitis C clinical manifestations and treatment strategies essays. A few patients with chronic hepatitis develop manifestations of cholestasis (eg, jaundice, pruritus, pale stools, and steatorrhea. Brau N. (2013). Evaluation of the hepatitis C virus-infected patient: the initial encounter. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America, 56(6), 853–860. https://doi.org/10.1093/cid/cis957less1 UnreadUnread3 ViewsViews
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View profile card for Hilary Szpara
Last post February 25 at 11:45 AM by Hilary Szpara
Kim, A.I & Saab, S. (2019). Treatment of hepatitis C. Retrieved from https://www.amjmed.com/article/S0002-9343 (05)00335-9/pdf
References
The objective of therapy is to eradicate the virus and prevent potential complications from chronic hepatitis C infection. The risk of chronic disease in infected patients is greater than 80%.Among patients who develop chronic infection, 5% to 20% might develop cirrhosis, generally over the course of 20 to 30 years; among these cirrhotic patients, there is a 30% risk of developing decompensated liver disease after a decade, and a 1% to 2% yearly risk of developing hepatocellular carcinoma. Extra hepatic manifestations, such as cryoglobulinemia, that may lead to additional morbidity, and mortality must also be considered. Efficacy of the treatment is assessed by measurements of hepatitis C RNA viral load. The goal is to achieve a sustained virologic response, defined by the continued absence of hepatitis C RNA 6 months after the completion of treatment (Kim & Sab, 2019) Hepatitis C clinical manifestations and treatment strategies essays.
The only way to confirm a hepatitis C infection is through a blood test. The most common test is an HCV antibody test. A positive result means you’ve been exposed to the virus, but you may not have an infection. To confirm an HCV infection, you must undergo an HCV viral load test to check for genetic material (RNA)
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Aina Oluwo posted Feb 24, 2021 11:54 PM
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According to the center for disease control, Hepatitis C virus (HCV) infection affects millions of people in the United States and more studies over the years have shown that untreated Hepatitis C infections will eventually become chronic, which may progress to cirrhosis and complicated by hepatic de-compensation and hepatocellular carcinoma (HCC). In our case study patient Mike, he was essentially diagnosed with Hep C based on a lab order for LFT due to his use of depakote as Liver function tests (LFTs) are routinely performed for patients using valproic acid due to the risk of liver damage, but LFTs that are as high as Mike’s would be very unusual if related to his use of valproic acid (Gayam et al., 2018).Acute hepatitis C virus (HCV) infection should be suspected in patients with clinical labs or manifestations of acute hepatitis or with possible exposure to HCV (e.g., from a needle-stick). History from our patient gives a clear admission to illicit IV drug use approx. 8 weeks ago and with lab values as indicated with Mike’s ALT 1178 u/L and AST 746 u/L the clinical suspicion for Hep C is very high on the diagnosis. The ALT is normally <50 u/L in males and AST is >36 u/L in males or females (CDC, 2020). Additionally, he has elevated bilirubin and alkaline phosphatase levels which also point to liver disease. The confirmatory testing for Hep C will be the presence of HCV RNA and antibodies in the serum. The timing of
